Abdominal Pain During Pregnancy

Having abdominal pain during pregnancy? Find out if it warrants a call to the doctor.

WORDS SUE-ANN BAUMGÄRTEL

How the female body changes and prepares for its new role as a mother is an incredible feat of mechanics and engineering – albeit most probably designed by a man! From hormonal overdrive to the physical demands of carrying a baby around for nine months, a healthy female body is nonetheless designed to handle this transformation. And yet, it is all too easy to view pregnancy through rose-tinted glasses.

While most pregnant women continue to work and look after the family, a healthy pregnancy should not be taken for granted. Abdominal pains or discomfort is part and parcel of every pregnancy, whether you are a first-time mum or expecting your sixth baby. Although mostly harmless, abdominal pain can also be a sign of something far more serious. Being aware of what is happening to your body and listening to your body is an important part of being pregnant. According to gynaecologist, Dr Dharshini Gopalakrishnakone from The Obstetrics and Gynaecology Centre, Mount Elizabeth Novena Specialist Centre abdominal pain is “one of the biggest concerns” experienced by many pregnant women, as it is difficult “to decipher how serious their abdominal discomforts are”. Due to the many physical and hormonal changes taking place during pregnancy, the actual “causes of abdominal pain in pregnancy may be difficult to diagnose”. However, “it is better to play safe” and take heed of what your body is trying to tell you.

Constipation and Gas

The increase in progesterone during pregnancy slows down digestion, which can cause uncomfortable pressure and a feeling of bloatedness in the abdomen. As the body changes and the uterus expands, the stomach and digestive tract will also have less space. Drinking plenty of water – at least 1.5 litres a day – eating food rich in fibre can help alleviate this harmless problem. Eating smaller portions also puts less pressure on the digestive tract, while gentle exercise can aid digestion.

Round Ligament Pain

In order to carry a baby, the uterus will be stretched to its limit. As the uterus stretches, so do the ligaments around it. This stretching can be a short sharp pain or a dull ache, which can be felt in the lower abdomen and groin area. It usually occurs from the second trimester onwards. Changing your position can lessen the pain. In certain cases, “a referral to a good physiotherapist or chiropractor can alleviate general aches,” says Dr Dharshini, as “strong painkillers are best avoided”.

Implantation

Implantation occurs when a fertilised egg attaches itself to the uterine wall. It occurs very early on in pregnancy, around the time when your period should be or eight to 10 days after ovulation. Implantation can feel like a period cramp, and can also be accompanied by light spotting. Some women do not realise they are pregnant at this early stage. If you are trying for a baby, this would warrant a visit to your doctor.

Braxton Hicks Contractions

These “warm-up contractions” can start from 20 weeks onwards, and generally increases and intensifies as D-Day beckons. Braxton-Hicks contractions do not last long – anything from several seconds to two minutes – and are irregular. Dehydration can cause these contractions, so drink plenty of water. Braxton-Hicks also respond to changes in position – real contractions don’t!

Urinary Tract Infection

Being pregnant makes you more susceptible to UTIs. Symptoms can include a heavy pain in the abdomen, fever and chills, as well as a burning sensation while passing urine. The urine appears cloudy and can be foul smelling or bloody. There is also a definite sensation of needing to constantly pass urine. Although UTIs can be easily treated, it can also cause complications in pregnancy.

Ectopic Pregnancy

An ectopic pregnancy occurs when the fertilised egg implants outside of the womb. There is usually a sharp sudden pain, which doesn’t seem to go away, and is localised on one side. Any movement, such as coughing, climbing stairs or going to the toilet, can intensify the pain. Accompanying symptoms include vaginal bleeding, shoulder pain and dizziness. Left untreated, an ectopic pregnancy can be life-threatening – this requires immediate help.

Miscarriage

Sadly, one in five pregnancies end in miscarriage. It occurs most commonly in the first 13 weeks but can occur up to week 20. Vaginal spotting or bleeding is usually the first sign of a miscarriage. Bleeding can be light to heavy. This is usually followed by abdominal pains, which can range from mild to severe. ‘True’ contractions can also occur. Other accompanying symptoms can include an absence of foetal movement. This also requires immediate medical help.

Placental Abruption

Placental abruption is a serious condition in which the placenta detaches itself from the uterus before the baby is born. Symptoms include constant pain or cramping, unusual vaginal discharge (waters breaking) and bleeding. This condition requires immediate medical attention in order to determine the extent of the detachment.

Preeclampsia

Preeclampsia is a serious pregnancy-related condition, which can affect your organs and placenta. A high blood pressure accompanied with protein in your urine both point towards preeclampsia. Other symptoms include intense pain or tenderness in the upper abdomen and shoulder, a persistent headache, blurred vision, severe water retention, swelling and puffiness around the face and hands, and nausea. This condition also requires immediate medical attention.

Labour

Whether full-term or pre-term, labour contractions are regular cramps or pains, which intensify over a period of time. Each contraction can last up to 70 seconds, and certainly do not go away if you change positions. Contractions can be unassumingly dull, or extremely painful. A deep sensation of heavy pressure around the lower abdomen and groin area can also indicate labour. Accompanying symptoms can include vaginal discharge, such as your waters breaking. If the fluid is bloody or brownish in colour, seek immediate medical help, as this might indicate foetal distress. While some women might feel more comfortable remaining for the most part of their labour at home, medical attention and monitoring are highly recommended should you be in any stage of labour.

Non-pregnancy Related Conditions

These can include:

Appendicitis

Kidney stones

Gallstones

Bowel obstruction

Fibroids

Food sensitivities

Due to the enlarging uterus, the position of organs can shift, too, thus making diagnosis more complicated. “A quick examination of the mother and baby allows us to assess if either one is in any imminent danger,” says Dr Dharshini. In serious cases, an MRI scan can safely provide a clear picture of the possible cause.

While it is important to remain positive and centred during pregnancy, there are many symptoms that should not be ignored and brushed away. Contact your doctor if you experience any of the following symptoms:

Fever and chills

An abdominal pain, no matter how mild, that is constant and persistent

An abdominal pain that is sustained despite changing positions

An abdominal pain that intensifies or disturbs your sleep

Vaginal bleeding or spotting

Vaginal discharge of unusual colour, consistency and smell

Nausea and vomiting

Dizziness and feeling faint

Pain during urination

Change in vision. This can include blurred vision, flashing lights and temporary blindness

Regular contractions

Decreased foetal movement

“Occasional abdominal pain and discomfort is a very common and often harmless complaint during pregnancy”, says Dr Dharshini, “but it can also be a sign of a serious underlying problem. All pregnant women should never ignore severe or persistent abdominal pains.” After all, there is no prize for the perfect problem-free pregnancy. Every woman is different and every pregnancy is different – now is the time to listen to your body.

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